A new study finds that electronic medical records have failed to live up to expectations for reducing costs and improving patient care. The study was done by the same company that predicted electronic medical records would save the U.S. billions of dollars a year, and which sparked a national push toward conversion back in 2005. Patty Wight reports on what health care providers in Maine have found to be the benefits and challenges of electronic medical records.

Many health care providers agree that the switch to electronic medical records, or EMRs is a challenge. And some, like Dr. Jim Donahue, who runs a family practice in Freeport, say it's just not worth it. "Only because of the fact of the cost," he says. "After 38 years - although I'd like to practice as long as I possibly can - the payback doesn't exist in the practice. The systems themselves have a cost, but the big cost is training, employee time."

Donahue says electronic record systems alone can cost $50,000 to $80,000. Beyond the financial barrier, Donahue also thinks EMRs can erect a virtual barrier between doctors and their patients.

"I have patients who come back and say, 'I went to see your specialist and he never once made eye contact. He spent all of his time tapping on keyboards and looking at a screen and so I felt totally disconnected from the visit,'" Donahue says.

These are some of the problems identified in a study by the RAND corporation, a California-based non-profit, non-partisan research company. RAND found that while there is potential for EMRs to significantly improve patient care, increase efficiency and reduce costs, the reality often falls short.

Shaun Alfreds, Chief Operating Officer of HealthInfo Net - a Maine company that manages a centralized health records database for the state - says part of the problem may be the rush to implement EMRs over the past few years.

"And in this particular case, the focus was getting the systems to be electronic, not necessarily about changing the workflow of how health care is delivered." Because ultimately, Alfreds says, that's what EMRs are about: workflow.

Another problem that RAND identified is the inability of EMR systems to communicate with each other. "It's the bigggest challenge I've had in my career," says Ralph Johnson, chief information officer at Franklin Memorial Hospital in Farmington, which has been named among the nation's most wired hospitals.

"Part of it, quite frankly, is it speaks to the vendors. It's not in their business model for the various business members to cooperatively exchange data with other medical records," Johnson says. "They don't want you to buy a different system."

Franklin Memorial has been using EMRs for 15 years, and its physician practices have been using them for about three years. Johnson says the switch has paid off, both financially and in quality of care.

"Because we provide a lot of the primary care in Franklin County, as well as the hospital care, and we've seen a decrease in our emergency room admissions," he says. "But it took a few years to catch up. It's been in the last year or so that we've seen that decrease in volume."

The health care providers interviewed for this story say EMRs appear to work well in practices where the switch is driven more by a desire to improve care rather than by a desire to obtain stimulus money.

Sarah Hines is patient access manager at Coastal Women's Health Care in Scarborough, which switched to EMRs in 2008. She says now, when a patient calls in with a problem, a triage nurse can get an answer from a doctor within seconds, whereas before, "you know, a handwritten triage note put in a provider's mailox, or walk down to them as you stand outside an exam room waiting to get an answer. It's just overall a cleaner, more organized way of communication."

Shaun Alfreds of HealthInfo Net says the U.S. government needs to address some of the challenges with EMRs. Top on the list is institute standards so different systems can communicate. He says over time, he thinks the kinks will be worked out and the full value of EMRs will be achieved.